Government Tells States To See If Disabled Can Get Care At Home

A Supreme Court Ruling Prompted An Effort To Enforce The Americans With Disabilities Act.

February 13, 2000|By New York Times

WASHINGTON - Following up on a Supreme Court decision, the Clinton administration has told states to evaluate hundreds of thousands of people in nursing homes, mental hospitals and state institutions to see whether they could be receiving care in their own homes or elsewhere in their communities.

In a policy statement with far-reaching implications, the administration has informed states that to comply with the court ruling they will almost certainly have to provide more medical and social services and shift more people out of institutions and into small group homes or apartments.

``No person should have to live in a nursing home or other institution if he or she can live in his or her community,'' wrote Donna Shalala, the secretary of health and human services, in a letter sent last month to all governors. Moreover, she said, ``unnecessary institutionalization of individuals with disabilities is discrimination under the Americans With Disabilities Act.''

People with disabilities welcomed the administration's action, saying it would help them enforce their rights. But state officials said the policy went beyond the court ruling and could impose substantial new costs on states.

The state officials said that compliance would cost tens of millions of dollars in individual states and could cost over $2 billion a year nationwide. Federal officials said they had no immediate estimate of how much it would cost states to comply.

The federal government has some power to force states to comply because the states are required to meet federal standards as a condition of receiving Medicaid money and because the federal government enforces the Americans With Disabilities Act. But officials said they would prefer that the states cooperate in developing acceptable practices.

People who leave institutions to live in the community often need housing assistance, job training, medical care and personal attendants to help them with everyday activities. Many people spend years in institutions because these kinds of services are not available in less restrictive settings.

Federal officials said they wanted to know about any disabled person being unnecessarily confined to an institution, and they promised to investigate every complaint.